Health Homes Care Manager - Registered Nurse (HH223)

Title: Health Home Care Manager
Pay Rate: $32.00/hour
Schedule: 30 hours/week
Location: Baltimore City/Rosedale
Performs a full range of professional nursing services, including assessing, planning, administering, and evaluating patient care. Administers medical treatment as prescribed by physician and is responsible for teaching and providing psychosocial support to patients?. Facilitates coordination of care while monitors treatment adherence. Documents and reports patient status and progress to treatment team.
Care Managers are responsible for coordinating care for participants assigned to them, ensuring implementation of the treatment plan in partnership with the individual and family, conducting health promotion and education, providing referrals, and offering additional supports as needed.
Develop wellness & prevention initiatives.
Lead various patient group activities to enhance the therapeutic impact on patients and to improve skills.
Facilitate health education groups and provide direct health and prevention education to participants and caretakers/guardians, as appropriate.
Participate in the initial treatment plan development for all of their Health Home enrollees.
Assist in developing treatment plan health care goals for individuals with, or at risk for, co-occurring chronic diseases.
Consult with Community Support Staff about identified health conditions.
Assist in contacting medical providers & hospitals for admission/discharge.
Provide training on medical diseases, treatments & medications.
Track required assessments, screenings and immunizations.
Assist in implementing health technology programs & initiatives.
Monitor HIT tools and reports for treatment, medication alerts and hospital admissions/discharges.
Monitor and report performance measures and outcomes.
Participates in the evaluation of program effectiveness and efficiency and works to ensure continuous improvements in the quality of services.
Maintains professional knowledge and skills through attendance to professional meetings, workshops, courses, and in-service sessions.
Successfully complete all required trainings as assigned and within required timeframes.
Performs other direct job related duties as is assigned.
1. Work requires knowledge of nursing theory, principles, and practice-normally acquired through graduation of an accredited program of Nursing.
2. Requires possession of a current license as a Registered Nurse in the State of Maryland at the time of appointment.
3. Ability to coordinate primary and behavioral health care to address the whole-person needs of participants at both the individual and population levels.
4. Work requires analytical ability and sound nursing knowledge for the effective formulation of nursing care plans, implementation of care, and appropriate documentation of pertinent information regarding a patient?s condition.
5. Must have excellent interpersonal skills and the ability to interact effectively with psychiatrically ill patients in order to gain their cooperation, allay apprehensions and provide effective health education to patients and family members.
6. Must possess the ability to physically intervene in medical and behavioral emergencies, transport patients, and assist in the lifting of a patient.
7. Conversant with electronic health records and data analytics. Skills and experience in fundamental MIS design and basic computer skills including knowledge of Microsoft Office programs.
8. Must possess a valid Maryland State issued Driver?s License and have a current driving record with less than 3 points on it at the time of hire.
Normal activity-center environment, where there is no physical discomfort due to temperature, dust or noise.
Depending on position may have some exposure to cigarette smoke in area designated for client smoking.
Works in patient care environment where there is some exposure to communicable diseases and blood-borne pathogens.
Depending on specific assignment, work requires travel between programs and services.
Mosaic Community Services Inc. is an Equal Opportunity Employer.
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